Liquid Oxygen Therapy at home
SUMMARY
AGENCE D’ÉVALUATION DES TECHNOLOGIES
ET DES MODES D’INTERVENTION EN SANTÉ
Liquid Oxygen Therapy at Home
Report prepared for AETMIS by Susan Law
January 2005
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The content of this publication was written and produced by the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS). Both the original report and its French version, titled Oxygénothérapie à domicile : les appareils à oxygène liquide are available in PDF format on the AETMIS Web site.
Scientific review
Alicia Framarin, M.D., M.Sc.
Editorial supervision Suzie Toutant Proofreading Frédérique Stephan Page layout Jocelyne Guillot Frédérique Stephan Biographical verification Mathieu D’Amours Coordination Lise-Ann Davignon
Communications and dissemination Richard Lavoie, M.A. (Communication)
For information about this publication or any other AETMIS activity, please contact:
Agence d’évaluation des technologies et des modes d’intervention en santé 2021, avenue Union, bureau 1050
Montréal (Québec) H3A 2S9 Tel.: (514) 873-2563 Fax: (514) 873-1369
e-mail: [email protected] http://www.aetmis.gouv.qc.ca
How to cite this publication:
Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS). Liquid Oxygen Therapy at Home.
Report prepared by Susan Law (AETMIS 04-08). Montreal: AETMIS, 2005, vi-13 p.
Legal Deposit
Bibliothèque nationale du Québec, 2005 National Library of Canada, 2005
ISBN 2-550-43750-0 (French edition ISBN 2-550-43751-9)
© Gouvernement du Québec, 2005.
This report may be reproduced in whole or in part, provided that the source is cited.
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MISSION
The mission of the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS) is to contribute to improving the Québec health-care system and to participate in the im- plementation of the Québec government’s scientific policy. To accomplish this, the Agency advises and supports the Minister of Health and Social Services as well as the decision-makers in the health care system, in matters concerning the assessment of health services and technologies. The Agency makes recommendations based on scientific reports assessing the introduction, diffusion and use of health technologies, including technical aids for disabled persons, as well as the modes of providing and organizing services. The assessments take into account many factors, such as efficacy, safety and efficiency, as well as ethical, social, organizational and economic implications.
EXECUTIVE
Dr. Luc Deschênes
Cancer Surgeon, President and Chief Executive Officer of AETMIS, Montréal, and Chairman, Conseil médical du Québec, Québec
Dr. Véronique Déry
Public Health Physician, Chief Executive Officer and Scientific Director
Jean-Marie R. Lance
Economist, Senior Scientific Advisor Dr. Alicia Framarin
Physician, Scientific Advisor
BOARD OF DIRECTORS Dr. Jeffrey Barkun
Associate Professor, Department of Surgery, Faculty of Medicine, McGill University, and Surgeon, Royal Victoria Hospital (MUHC), Montréal
Dr. Marie-Dominique Beaulieu
Family Physician, Holder of the Dr. Sadok Besrour Chair in Family Medicine, CHUM, and Researcher, Unité de recherche évaluative, Hôpital Notre-Dame (CHUM), Montréal Dr. Suzanne Claveau
Specialist in microbiology and infectious diseases, Hôtel-Dieu de Québec (CHUQ), Québec
Roger Jacob
Biomedical Engineer, Coordinator, Services des immobilisations, Agence de développement de réseaux locaux de services de santé et de services sociaux de Montréal, Montréal Denise Leclerc
Pharmacist, Board Member of the Institut universitaire de gériatrie de Montréal, Montréal
Louise Montreuil
Assistant Executive Director, Direction générale de la coordination ministérielle des relations avec le réseau, ministère de la Santé et des Services sociaux, Québec
Dr. Jean-Marie Moutquin
Obstetrician/Gynecologist, Scientific Director, Centre de recherche, CHUS, Sherbrooke Dr. Réginald Nadeau
Cardiologist, Hôpital du Sacré-Cœur, Montréal, Board Member of the Conseil du médicament du Québec, Québec
Guy Rocher
Sociologist, Professor, Département de sociologie, and Researcher, Centre de recherche en droit public, Université de Montréal, Montréal
Lee Soderström
Economist, Professor, Department of Economics, McGill University, Montréal
AETM
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FOREWORD
The benefits of long term oxygen therapy for chronic obstructive pulmonary disease (COPD) have been well established and there is good consensus internationally around clinical indications for re- ferral and treatment. There is, however, only limited evidence and guidance about the use of portable oxygen systems (liquid or gas) at home as a component of long term oxygen therapy.
The Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS) recently published a report on home oxygen therapy, and was subsequently asked by the Québec Ministry of Health and Social Services to examine the available evidence specific to liquid oxygen therapy, in terms of costs and benefits, and the implications for the home oxygen program in Québec.
Liquid oxygen systems for home use were introduced in the 1980s to offer patients the convenience of smaller, lighter equipment that delivered oxygen for an extended time period outside the home, in comparison to other oxygen delivery systems. There is a wide variation in the use of liquid oxygen at home and in the organization of services within and across jurisdictions. Technology in this area continues to evolve rapidly, although the specific benefits to patients have not been adequately documented. There is scant evidence regarding the contribution of liquid systems to enhanced dura- tion and quality of life in comparison to other systems; there is some evidence that the technology has some advantages in terms of user-friendliness. Guidelines for use have recently been published in the United Kingdom and the United States that suggest criteria related to the patient’s mobility, us- age, and compliance.
There is no routine data available about the cost or utilization of liquid oxygen therapy in Québec, although its use is known to be rare as a ‘traitement d’exception’ in the public system, given the rela- tively higher cost and clinical concerns about added benefit. Its use is higher in Ontario where it is covered by the provincial Home Oxygen Program. It is likely that this technology would offer some benefit to active COPD patients although the identification of clinical and social criteria for assess- ment and monitoring should be developed by clinicians and decision-makers in Québec within the context of a comprehensive home oxygen program.
In submitting this report, AETMIS aims to contribute to informed decision-making across Québec with respect to what is currently known and what information we need in order to establish evidence- based policy and practice for the use of liquid oxygen therapy at home.
Dr. Luc Deschênes
Chairman and Chief Executive Officer
ACKNOWLEDGEMENTS
This report was prepared by Susan Law, MHSc, Consultant Researcher, at the request of the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS).
The following individuals were instrumental in providing key support, information and guidance in the preparation of this report:
EXTERNAL REVIEWERS
Dr. Yves Lacasse
Respirologist, Hôpital Laval, Quebec City
Ms. Danielle St-Jules
RN, Head of the Regional Department for Home Care Services, Hôpital Maisonneuve-Rosemont, Montreal
AETMIS INFORMATION SPECIALISTS Pierre Vincent
Micheline Paquin
CONFLICT OF INTEREST None declared.
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SUMMARY
INTRODUCTION
The benefits of long term oxygen therapy (LTOT) for chronic obstructive pulmonary disease (COPD) are well established. Portable oxygen systems have been assessed in an AETMIS report published in 2004. These systems, developed to provide patients who are active outside the home with an oxygen supply include compressed gas systems, liquid oxygen systems, and oxygen concentrators.
This report presents the results of a compre- hensive literature review, prepared in response to a request from the Québec Ministry of Health and Social Services to examine the available evidence about the indications, clinical efficiency, and cost-effectiveness of liquid oxygen therapy as well as the implica- tions on the organization of and access to the home oxygen program in Québec.
METHODOLOGY
A search and review of the scientific literature was undertaken in a number of databases including those of Health Assessment Agen- cies and of the International Network of Agencies for Health Technology Assessment (INAHTA). Other documents and government reports have also been reviewed.
RESULTS
Although there are no published clinical indi- cations for the use of liquid oxygen systems at home, the prescription criteria of the available guidelines are based on patient’s mobility and usage. The lighter liquid oxygen systems are recommended for LTOT-dependent patients who need to go outside their home on a regu- lar basis.
There are no existing data which would indi- cate that liquid oxygen systems allow for ex- tended daily duration of therapy or for im- proved quality of life in comparison to other oxygen supply systems (portable or station-
ary). Furthermore, there is limited evidence that this technology is more user-friendly and advantageous than the compressed gas sys- tems. Comparative costs were reported in one study conducted in Sweden which reveals that liquid oxygen is four times as expensive as the standard therapy (concentrator plus portable cylinder). Utilization of liquid oxygen systems and access to this treatment vary within and across jurisdictions, and depend on the pa- tients insurance coverage. In Canada, the use of liquid oxygen systems is higher in Ontario where it is covered by the provincial Home Oxygen Program. In Québec, given the rela- tively higher cost and clinical concerns about added benefit, liquid oxygen systems are of- fered in the public system only as a ‘traite- ment d’exception’ to patients who spend lengthy periods of time out of their home ei- ther for work or for leisure or need high flow rates. Nevertheless, patients who wish to use these systems can buy one directly from a supplier.
New systems of portable oxygen supply, such as a portable concentrator that has been devel- oped in Montreal and is being tested for clini- cal use, may in the future compete as alterna- tives to liquid oxygen therapy.
CONCLUSION
There is very limited information about the effectiveness of liquid oxygen therapy in comparison to compressed gas delivery sys- tems in terms of enhanced patient compliance, mobility, or quality of life. A small minority of patients with COPD on LTOT who have active lifestyles would likely benefit from the enhanced portability of liquid oxygen therapy.
The identification of clinical and social indi- cations or assessment criteria for the use of liquid oxygen therapy should be determined through a process of consensus amongst respi- rologists and decision-makers in Québec, within the context of developing overall guidelines for home oxygen programs.
